How to Apply

We know how busy you can be with your practice. That's why we've made it easier to apply for the D.C. Long Term Disability Insurance Plan, issued by The Prudential Insurance Company of America. You can do it right now with a simplified application.*

What you'll need

To select your monthly benefit amount, you’ll need to know your monthly earnings amount. Have the IRS federal income tax forms for the last two years handy for reference.

Review details

This site gives general information on the benefits and features of the D.C. Long Term Disability Insurance Plan. The Certificate of Coverage will include any exclusions, limitations and restrictions which may apply.

State availability

The D.C. Long Term Disability Insurance Plan is currently not available in Alaska.

When your coverage will start

Your D.C. Long Term Disability Insurance Plan will become effective on the first day of the month after you have been approved and have paid the first premium, as long as you are working at least 30 hours a week. (If you are not working at least 30 hours a week, coverage will start the first of the month after you return to working at least 30 hours a week.)

Get a quote now

Find out how affordable this coverage can be and get a quote right now. Once you see your quote, you will have the opportunity to complete an online application.

Or, download an application

If you choose not to complete an application online, you can download one. Simply click on the appropriate link below to access the form you need. Then, mail, fax or email your completed form back to us. If you have any questions, please call 1-800-769-2000, ext. 8640 so an NCMIC Client Representative can help you.

For all states except North Carolina and Virginia, click here.

For D.C.s in North Carolina, click here.

For D.C.s in Virginia, click here.

EASY TO APPLY!

It's easy to apply for this vital protection. Complete and return your application today.

  *Please note: The shorter application has not been approved in Virginia. D.C.s in Virginia can complete the regular application. 
   Coverage under the D.C. Long Term Disability Insurance Plan is issued by The Prudential Insurance Company of America, Newark, NJ. Please refer to your certificate for Plan details, including any exclusions, limitations and restrictions which may apply. Contract series 83500. CA COA #1179. NAIC #68241.
  This plan is not available in Alaska.
  This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York Department of Financial Services.
  North Carolina residents: THIS IS NOT A MEDICARE SUPPLEMENT PLAN. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare, which is available from the company.
   This site may contain marketing language, on products issued by The Prudential Insurance Company of America, that has not yet been approved in all states.
  The contract holder for the D.C. Long Term Disability Insurance Plan is the National Business Association for Chiropractors (NBAC). NCMIC Insurance Services, the exclusive agent, is a licensed insurance agency. California license #0B84564. IA License #2002515. In NY: NCMIC Insurance Agency. In MI: NCMIC Insurance Services Agency, Inc.

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